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Wayne State University researcher defines new treatment intervention recommendations for mini-strokes

June 8, 2009

May lead to reduced rates of strokes and further brain damage

DETROIT-A Wayne State University School of Medicine professor has co-written a new definition and national treatment recommendations for transient ischemic attacks (TIA) or "mini-strokes." The new guidelines call for much faster intervention treatment for TIA symptoms than previously practiced.

Seemant Chaturvedi, M.D., F.A.A.N., F.A.H.A., professor of neurology and director of the WSU/DMC Stroke Program, played a key role in research that reviewed 17 years' worth of findings to develop the new definition and recommendation.

The findings and new recommendations, affirmed by the American Academy of Neurology, indicate that while TIAs were previously defined as any focal cerebral ischemic event with symptoms lasting 24 hours, that time frame was too broad. Review of the research showed that with use of the 24-hour rule, 30 to 50 percent of TIA cases developed permanent brain injury.

In effect, the paper says, waiting for a TIA symptom to last 24 hours delays treatment that could prevent a stroke and further damage to the brain.

Some physicians, Chaturvedi said, are reluctant to initiate acute stroke intervention because of concerns that symptoms may resolve spontaneously. The former standby of a 24-hour definition for TIA encourages a "wait and see" approach over immediate intervention. Patients with TIA symptoms lasting more than just a single hour, however, are "highly likely" to develop permanent damage if treatment is not provided immediately.

"TIAs are often not recognized by patients as well as primary care physicians," Dr. Chaturvedi said. "This document provides current thinking on the appropriate diagnosis and evaluation of suspected TIAs. TIAs are an important warning sign of a potential future stroke, and this paper from the American Heart Association/Stroke Association reinforces this message."

Acute stroke interventions such as intravenous tissue plasminogen activator must be administered much sooner than 24 hours after symptom onset. The sooner tissue plasminogen activator is administered, the greater its efficacy.

Chaturvedi, co-author of the 2004 book "Transient Ischemic Attacks," is president of the Michigan Neurological Association.

His new diagnostic recommendations include that suspected TIA patients undergo neuroimaging evaluation within 24 hours of symptom onset, preferably with magnetic resonance imaging. In addition, noninvasive imaging of the cervical vessels should be performed and noninvasive imaging of intracranial vessels is considered "reasonable."

The paper, "Definition and Evaluation of Transient Ischemic Attack: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease," was published in the May issue of Stroke, the online Journal of the American Heart Association.

Wayne State University is one of the nation's pre-eminent public research universities in an urban setting, ranking in the top 50 in R & D expenditures of all public universities by the National Science Foundation. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world.